Intravenous contrast requires that the patient have good renal function with a GFR greater than 60. Administration of intravenous contrast is decided individually on a case-by-case basis with a GFR greater than 30 and less than 60.

In-111 tagged WBC scan with Tc-99m Sulfur Colloid Marrow Mapping

Advantages

Useful if suspecting multifocal osteomyelitis, as a larger region or the whole body may be imaged.

May be used despite CT or MR contraindications

Disadvantages

May be falsely positive in patients with recent fractures or orthopedic postsurgical change

Not sensitive for spinal osteomyelitis

Lacks anatomic detail afforded by CT and MR

Exposes patient to more radiation than if CT, plain film, or MR were utilized

Requires significant patient cooperation, often requiring patients not to move for prolonged periods

VI. What are the contraindications for the alternative imaging techniques?

MRI with Gadolinium

Contraindicated in patients with non–MR-compatible metallic hardware or foreign bodies

Gadolinium is contraindicated in the patient with impaired renal function and a GFR less than 30. Administration of intravenous contrast is decided individually on a case-by-case basis with a GFR greater than 30 and less than 60.

Contrast enhanced CT

Contraindicated in pregnant women especially within the first two trimesters.

Patients with allergic reactions (eg, itching, rash) to intravenous contrast and more severe allergic reactions (eg, angioedema of the throat, anaphylaxis) should be pretreated with steroids and antihistamines for a minimum of 13 hours prior to CT imaging with IV contrast.

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